tbuckley/cabot-search huggingface dataset:
Body image disturbances in adolescent and young adult patients with cancer confronting infertility risk and fertility preservation decisions.
Authors: Victoria A Wytiaz, Nina Levin, Chiu Yi Joey Tan, Daria Stelmak, Nicholas Iannarino, Anao Zhang, Erin Ellman, Lindsey A. Herrel, Molly Moravek, Emily Byrnes Walling, Rashmi Chugh, Brad J. Zebrack
Journal: Journal of Clinical Oncology (2023)

e24175 Background: Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to better elucidate the relationship between oncofertility discussions and body image disturbances in the AYA cancer population. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred the risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. Results: Body image concerns, including those related to both physical appearance and body functioning, emerged as common themes. Specific concerns included 1) anticipating and coping with body changes, 2) discomfort in experiencing and discussing one’s own body, 3) fear of judgement, and 4) failing to meet both internal and external expectations of the body. Some participants expressed a sense of loss when learning about infertility risk and the emotional challenges associated with accepting this risk. Several respondents worried that they would be negatively judged by their peers for a perceived defect of the body. Still others struggled with facing the unknown regarding fertility preservation and the difficulty in sharing this information with loved ones and future romantic partners. Conclusions: AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and decisions regarding fertility preservation. In identifying and exploring these themes, future opportunities, and novel interventions for improving oncofertility practice and discussions among AYAs with a focus on body image positivity emerge. These include the dual involvement of multidisciplinary teams (oncology and reproductive medicine) at initial clinical consultation and frequent follow-up contact; AYA and oncofertility-specific peer support programs, both in-person and virtual; and early, frequent involvement of social workers and mental health providers experienced in both cancer care and reproductive medicine.
Influence of genetic predisposition and lifestyle on modifiable cardiovascular risk factors among survivors of childhood cancer.
Authors: Carmen L Wilson, Rikeenkumar Dhaduk, Xin Zhou, Gavriel Matt, Yutaka Yasui, Cindy Im, Gregory T. Armstrong, Stephanie B Dixon, Yadav Sapkota, Zhaoming Wang, Melissa M. Hudson, Leslie L. Robison, Kirsten K. Ness
Journal: Journal of Clinical Oncology (2023)

10061 Background: We aimed to evaluate associations between polygenic risk score (PRS), and lifestyle with cardiovascular risk factors (CVRFs) assessed as continuous phenotypes (LDL, HDL, triglycerides, fasting glucose [FG], systolic [SBP] and diastolic blood pressure [DBP]) among childhood cancer survivors. Methods: Participants included 2,347 White survivors (mean age=35.5 (±9.3) years) enrolled in the St. Jude Lifetime Cohort. Phenotype-specific PRS (derived from general population) were divided into tertiles and survivors classified as being at low-, intermediate-, or high-genetic risk. Lifestyle, classified as good, intermediate, or poor, was assessed based on four factors (smoking [yes/no], physical activity [meeting CDC guidelines for physical activity], diet quality [Healthy Eating Index score &gt;59], and obesity [BMI≥30kg/m 2 ]). A general linear model was created for each CVRF in which the effect of lifestyle (good, intermediate, poor) was examined within genetic risk group (low, intermediate, high), adjusting for sex, age, cancer therapies and current medication use. Results: The table shows worsening CVRF profiles associated with declining lifestyle and with increasing genetic risk. For example, among survivors with poor lifestyle-high genetic risk, SBP and DBP were higher on average by 14 (95% CI = 9-18) and 9 (95% CI = 6-12) mmHg respectively, compared to survivors with good lifestyle-low genetic risk. In analyses restricted to survivors with high genetic risk, mean SBP (7, 95% CI=2-12) mmHg, DBP (4, 95% CI=1-7) mmHg, triglyceride (61, 95% CI=5-117) mg/dL, and FG (7, 95% CI=4-10) mg/dL values were higher among survivors with poor versus good lifestyle, while mean HDL was lower (-13, 95% CI= -8- -18) mg/dL. Conclusions: While the risk of CVRFs among cancer survivors are associated with high genetic risk and cancer therapies, healthy lifestyle choices may partially ameliorate perturbations in CVRFs even among those with high genetic risk. Our findings highlight the importance of developing interventions targeting modifiable behaviors in this high-risk population. [Table: see text]
Burnout in oncology nurses.
Authors: Priyanshi Rajesh Sharma, Rajesh Sharma
Journal: Journal of Clinical Oncology (2023)

e23000 Background: Burnout is a psychological condition that develops as a result of a sustained response to workplace interpersonal stressors. An overpowering sense of tiredness, feelings of cynicism and detachment from the job, and a sense of ineffectiveness &amp; lack of accomplishment are the three primary dimensions of this response. Introduction: Specialties that is most impacted by burnout is oncology nursing. They work in environments with high patient: nurse ratios &amp; demanding working conditions, which increases their load of emotional responsibility and increases the risk of burnout. The current research was done to determine the predictors of burnout in an Indian healthcare population due to the scarcity of Indian studies in this domain. Objective: The aim to this research is to investigate the level of burnout &amp; fatigue in oncology nurses and how can we help them to recover from burnout. Outcomes are measured by Maslach Burnout Inventory test (MBI). Methods: In this study, total 300 nursing staff were included who are working in Oncology departments. The questionnaire comprised a total of 23 questions.The online surveys (Google form) were sent over 4-month period during April 2022 to June 2022 and nurses were met in person to interview and get the feedback submitted. The data were entered in the excel sheet and descriptive statistics were used to analyse the data using SPSS 20.0. The Mann-Whitney U test is used to compare differences between two independent groups. Logistic regression with stepwise selection was employed in multivariate analyses to find a group of demographic variables (age, gender) that were independently important in explaining the likelihood of burnout &amp; fatigue in nurses. Results: In this study, 33.7% (101) male and 66.3% (199) of female nurses were included with highest number from the young age group 20-25 (51%, 153). The univariate analysis revealed that fatigue during daily routine shown significant association with gender and age classification, however positively dealing with anger, all the time energetic feelings, consideration themselves as happy person also shown statistical significance. It was found that the think of themselves during a busy time at work showed a significant association with gender classification in multivariate analysis. Similarly, dealing with anger was the most critical positive association with burnout variables in multivariate analysis. The overall multivariate test results on the basis of gender classification showed a significant difference for the burnout variables (p&lt;0.01), while for age classification it was non-significant (p=0.87). Conclusions: The current study is a first step in understanding some of these mental health problems that Indian oncology nurses encounter and indicated prevalence of burnout consistent with age and gender criteria through standardizing measurement tools. It is helpful in raising awareness of the value of self-care and illnesses like burnout &amp; fatigue among nursing professionals.
Falls and hospitalization during chemotherapy in older women with early breast cancer.
Authors: Jingran Ji, Can-Lan Sun, Tanya Marya Wildes, Rachel A. Freedman, Allison Magnuson, Tracy O'Connor, Beverly Moy, Heidi D. Klepin, Andrew E. Chapman, William P. Tew, Efrat Dotan, Mary Anne Fenton, Heeyoung Kim, Marie Bae, Vani Katheria, Cary Philip Gross, Hyman B. Muss, Harvey Jay Cohen, Mina S. Sedrak
Journal: Journal of Clinical Oncology (2023)

12035 Background: Hospitalizations are frequent, burdensome, and potentially avoidable complications of cancer treatment in older adults. While geriatric assessments can identify older patients at risk for hospitalization, the use of these assessments in clinic is limited by time and resources. Screening for falls in the past 6 months is a quick and simple question that clinicians can ask in clinic and fall history has been linked to chemo-related toxicity. Here, we hypothesized that in older adults with cancer fall history prior to chemo is associated with an increased risk of hospitalization during chemo. Methods: In a prospective multicenter study of 497 women age ≥65 with stage I-III breast cancer treated with neo/adjuvant chemo, we assessed baseline self-reported fall history in the past 6 months as a dichotomous (yes/no) and continuous variable (no. of falls). Our primary endpoint was hospitalization during chemo (yes/no, yes defined as incident hospitalization assessed from start to end of chemo and attributed to toxicity from chemo). We used multivariable logistic regression to examine the association between fall history and hospitalization during chemo, adjusting for sociodemographic and clinical covariates. Results: The median age was 70 (65-86), 65% had stage II/III disease, 37% had anthracycline, and 72% received primary prophylaxis with G-CSF. Of the 497 participants, 60 (12%) reported falls (median 1.0 [1-6]) at baseline, and 114 (23%) were hospitalized during chemo (median 1.0 [1-4]). The most common toxicities that resulted in hospitalization were febrile neutropenia (25%), anemia (13%), dehydration (13%), and fatigue (13%). Women who fell in the 6 months prior to chemo had greater odds (adjusted OR = 2.69, 95% CI 1.42-5.11, p= 0.003) of being hospitalized during chemo compared to women who did not fall. Conclusions: In this cohort of older women with early breast cancer, fall history prior to chemo was associated with an increased risk of hospitalization during chemo, independent of sociodemographic and clinical factors. Oncologists do not routinely assess fall history when considering chemo in older adults. Screening for falls is a quick, simple, and important indicator of vulnerability that oncologists may use to identify patients at risk for hospitalization during chemo and inform personalized, patient-partnered treatment decisions. Clinical trial information: NCT01472094 . [Table: see text]
A pilot study of intraneural facilitation versus standard physical therapy for prevention of chemotherapy-induced peripheral neuropathy.
Authors: Dan Ran Castillo, Won Jin Jeon, Carvy Floyd Lucero, Mark Bussell, Ron Coleman, Karla Pieters, Jamie Hankins, Annette Boggs, Salem Dehom, Lorena Garcia, Ellen D'Errico, Gayathri Nagaraj
Journal: Journal of Clinical Oncology (2023)

12068 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side effect necessitating chemotherapy (CT) dose adjustments or early termination. Intraneural Facilitation (INF) is a novel form of manual physical therapy (PT) developed to mitigate CIPN-related symptoms and improve patients’ functional outcome. We conducted a randomized pilot study evaluating the efficacy of INF vs. standard PT in the prevention of CIPN (NCT 03272919). Methods: Eligible participants were patients with newly diagnosed breast cancer (stages I-III) and gynecologic cancer without preexisting peripheral neuropathy planning to receive platinum-based and/or taxane-based CT. Participants were randomly assigned to either INF or PT arm and received two 45-minute treatments twice a week for six weeks during their CT course. Outcomes reported here are a) assessment of pain between the 2 arms using the Pain Quality Assessment Scale (PQAS), and b) measurement of vascular patterns using ultrasound (US), evaluating pulsatility index, volume flow and peak systolic velocity between the 2 arms. Participants were evaluated at baseline, week 3 (W3), week 6 (W6), and month 3 (M3). PQAS scores ranged from 0 to 10 with subscale evaluations of paroxysmal, surface, and deep pain. Pain scores on a scale from 0 to 10 were grouped into none (0), mild (1-3), moderate (4-6) and severe (7-10). The use of neuropathy medications, CT dose reductions, premature CT discontinuation and participant satisfaction surveys between the two groups were previously reported at SABCS 2022. Results: Of 104 screened participants, 44 met the eligibility criteria, with 38 eligible for analysis (n=20 INF arm and n=18 PT arm). Participants reporting moderate or severe pain in either arm were combined (Table). Pain symptoms peaked at W6 coinciding with cumulative CT effects. At M3, none in the INF arm reported moderate or severe paroxysmal pain compared to two participants in the PT arm. One participant in each arm reported moderate or severe surface or deep pain at M3. The US results showed physiologic impact in both arms at W3 and W6, suggesting their role in preserving neural tissue blood flow and reducing vascular damage. Conclusions: Our study shows fewer number of participants on both intervention arms reporting pain, with numerically lower scores on PQAS in INF arm compared to PT arm, especially during ongoing CT. The US results suggest that INF has a unique pathophysiological impact on the microvasculature compared to standard PT; further studies are needed to validate these findings and potentially address their clinical significance as a combined modality. Clinical trial information: NCT03272919 . [Table: see text]
Toxicity profile, palliative care and hospice utilization of geriatric patients with hepatocellular carcinoma treated with atezolizumab plus bevacizumab in the veteran health administration.
Authors: Kana Lucero, Munaf Alkadimi, Lauren Diaz Boyle, Maria Elena Fierro, Kathleen Franklin, Michael Mader, Zohra Nooruddin
Journal: Journal of Clinical Oncology (2023)

e24022 Background: Over the last decade, the incidence of Hepatocellular carcinoma (HCC) has increased in the geriatric population. Atezolizumab plus Bevacizumab (A+B) has become an established systemic therapy for patients with HCC. Even with the aging population and elevated prevalence of HCC amongst Veterans, limited studies have explored the safety of A+B in geriatric patients. This study aims to investigate the toxicity profile of A+B in the geriatric population as well as Palliative Care and Hospice utilization within the Veteran Health Administration (VHA). Methods: Data were extracted from the electronic medical records (EMR) for adults (deceased and living) with ICD9 and ICD10 HCC codes that received 1st line systemic therapy with A+B within the VHA between December 1, 2019, and March 1, 2023. Descriptive statistics were used to summarize baseline characteristics, toxicity profile and Palliative Care and Hospice enrollment between 3 populations aged &lt; 65, 65-69, and &gt; 70 years. A significant p-value of ≤0.05 was used. Results: In total, 332 patients were included in the study; 206 were deceased. Approximately 70% of patients were &gt; 65 years. The majority in each age group were non-Hispanic white males, ECOG ≥1, CPS class A and BCLC score of C. Veterans &gt; 70, significantly had less cirrhosis caused by viral hepatitis(p &lt; 0.0001) and no prior local therapy (p = 0.002). There was no significant difference in either median A+B doses, cessation of therapy due to toxicities or median reported toxicities of any grade, as reported in Table 1. Most common toxicities in all age groups were fatigue, decreased appetite, proteinuria and transaminitis. There was a significant difference in Hospice enrollment in deceased patients (p = 0.027), with Veterans &gt; 70 years more likely to enroll in Hospice. Conclusions: This is the first known study that reports geriatric advanced HCC patients with A+Z toxicities in VHA patients. This study demonstrates that A+Z can be used safely in geriatric patients. Further quality improvements projects need to be implemented to improve number and timing Hospice utilization.[Table: see text]
Clinical outcomes with frontline immunotherapy (IO) in BRAF-mutant NSCLC.
Authors: Julian A. Marin-Acevedo, Ram Thapa, Sonam Puri, James Kevin Hicks, Jhanelle Elaine Gray
Journal: Journal of Clinical Oncology (2023)

e21089 Background: Oncogenic BRAF mutations are present in approximately 4% of non-small cell lung cancers (NSCLC). They are categorized as class I, II, or III according to their effect on the MAPK pathway. Little is known about how oncogenic BRAF mutations influence tumor PD-L1 expression and response to IO. We evaluated the clinical outcomes of frontline IO among BRAF classes. Methods: We performed a retrospective analysis of patients with BR AF-mutant NSCLC from January 1, 2012 through March 30, 2020. BRAF mutations were detected using next-generation sequencing or genotyping methods. PD-L1 expression was assessed using 22C3 or SP263 assays. Patient demographics were collected through electronic medical records review. In those with advanced/metastatic disease, we captured response to anticancer therapies using standardized real-world (rw) criteria and calculated rwOS using Kaplan-Meier method with log-rank test. Results: Of all 9,004 lung cancer patients (all histologies) with genotyping testing, 79 had NSCLC and an oncogenic BRAF mutation. 52% were females, 95% had adenocarcinoma, 81% were active/former smokers, and 76% had PD-L1 ≥1%. 39 patients had class I, 24 had class II, and 16 had class III mutations. Of these, 43 patients had advanced/metastatic disease evaluable for response. Patients with class I mutations who received first-line IO trended towards improved rwOS (42.6 months) vs. frontline anti-BRAF therapy (22.7 months; p= 0.51) and chemotherapy (19.6 months; p= 0.63). Patients with non-class I mutations, also trended towards improved rwOS with frontline IO (18.8 months) compared to frontline chemotherapy (9.9 months; p= 0.25). Outcomes were better in all patients with PD-L1 levels ≥1% and ≥50% who received IO. Patients with non-class I variants tended to have shorter rwOS with IO or chemotherapy compared to those with class I mutations (Table 1). Despite an overall trend towards improved outcomes with first-line IO, results did not reach significance likely due to the limited number of evaluable patients. Conclusions: The use of frontline IO may be associated with better outcomes than frontline chemotherapy or targeted therapies in patients with BRAF-mutant NSCLC. Patients with class I mutations and/or higher tumor PD-L1 expression seem to derive the most benefit. [Table: see text]
Trends in breast cancer death by stage at diagnoses in 2000-2018.
Authors: Adriana Matutino Kahn, Michal Marczyk, Andrea Silber, Mariya Rozenblit, Tara B. Sanft, Michael DiGiovanna, Sarah Schellhorn, Ian E. Krop, Maryam B. Lustberg, Eric P. Winer, Lajos Pusztai
Journal: Journal of Clinical Oncology (2023)

e18855 Background: Approximately 40-45,000, women die from breast cancer each year, most of which are due to metastatic recurrence of stage I-III cancers. Stage I and II cancers are considered highly curable, but they also include most patients. The goal of this analysis is to examine the contribution of stage I, II, III, and IV disease to annual breast cancer-specific death and assess time trends. Methods: Data from patients diagnosed with stage I-IV breast cancer between 1975-2018 (N = 1,545,502) were obtained from The Surveillance, Epidemiology, and End Results (SEER) Program. After filtering for the female sex, one primary site only, surgery performed, known AJCC stage &gt; 0, and survival data available we included N = 1,018,331 patients. We estimated the year of breast cancer-specific death (BCSD) by adding time to BCSD to a year of diagnosis for each patient. We summarized the proportion of BCSD by stage at diagnosis in each year between 2000 and 2017. All temporal trends were assessed by fitting the linear model with interactions between stage and year, then running the ANOVA to test model coefficient significance. For each year of diagnosis, Kaplan-Meier curves were fitted to patient data grouped by stage, and 5-year survival was estimated. Results: The study population included 24% ER-, 73% ER+ (the rest unknown) cancers; 35% HER2-, 6% HER2+ (the rest unknown); 24% were &lt; 50 and 76% &gt; 50 years of age; 60% received adjuvant chemotherapy. Over time, the frequency of stage I cancers increased from 49% in 2000 to 54% by 2017 (slope = 0.37 [95% CI: 0.32; 0.42]), and stage II and III decreased from 35.2% to 34.9% (slope = - 0.09 [-0.15; -0.04]) and from 14% to 10% (slope = -0.23 [-0.29; -0.18]), respectively. Five-year breast cancer-specific survivals remained stable for stage I cancers and increased significantly for stage II (slope = 0.002 [0.001;0.003]), stage III (slope = 0.006 [0.005;0.007]) and IV cancers (slope = 0.011 [0.010; 0.012]). The contribution of stage I cancers to annual breast cancer death increased and reached 23% in 2017, while death from stage III disease decreased to 30%. Since 2003, &gt; 50% of breast cancer deaths are from stage I-II cancers. Conclusions: The prevalence of stage I breast cancers increased in the past 20 years, and despite excellent overall prognosis, stage I-II cancers account for over 60% of all BCSD. To substantially reduce breast cancer death, we need to better identify the minority of Stage I-II patients who remain at risk for recurrence and death. [Table: see text]